Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients

Abstract

Introduction Intertrochanteric (IT) fractures that fail fixation are traditionally treated with arthroplasty, introducing significant risk of morbidity and mortality in frail older adult patients. Revision fixation with cement augmentation is a relatively novel technique that has been reported in several small scale international studies. Here we report a clinical series of 22 patients that underwent revision fixation with cement augmentation for IT fracture fixation failure. Methods This retrospective case series identified all patients that underwent revision intramedullary nailing from 2018 to 2021 at two institutions within a large metropolitan healthcare system. Demographics, injury characteristics, Charlson Comorbidity Index score, and surgical characteristics were extracted from the electronic medical record. Outcomes were extracted from the electronic medical record and included radiographic findings, pain, functional outcomes, complications, and mortality. Results Average follow-up after revision surgery was 15.2 ± 10.6 months. Twenty patients (90.9%) reported improved pain and achieved union or progressive healing after surgery. Most of these patients regained some degree of independent ambulation (19 patients, 86.4%), with only 5 patients (22.7%) requiring increased assistance for their activities of daily living (ADLs). One-year mortality was 13.6% (3 patients). Of the 5 patients (22.7%) that experienced complications, 2 patients (9.1%) required revision hemiarthroplasty for subsequent fixation failure. The other 3 patients did well when complications resolved. Conclusions Revision fixation with cement augmentation can be an effective, safe, cost-effective alternative to arthroplasty for the management of cases involving non-infected failed IT fracture fixation with implant cut-out or cut-through limited to the femoral head in older adult patients that have appropriate acetabular bone stock.

Orthopedic Surgery Residency Program Rankings and Gender Diversity

“…Therefore, while our study did not find a significant difference between the proportion of women in program directorship of the top and bottom 50 of the programs we included, it is likely that there will be a significantly higher proportion of female program directors in the top 100 programs we included vs. the bottom 100. Furthermore, given the results of our study, the Julian et al five-year update, and the Huyke-Hernandez et al “top-tier” program analysis, future studies can hypothesize that the faculty of higher-ranked programs are more gender diverse, which could correlate with the higher proportion of female leaders [ 18 ] and residents (our present study) at higher-ranked programs.…”

“…We examined program directors from the top 100 programs based on reputation, while Elkadi et al assessed those from 200 orthopedic residency programs, suggesting increased female representation in program directorship at higher-ranked programs [ 17 ]. Indeed, a paper investigating the characteristics of leadership in “top-tier” orthopedic surgery residency programs supports this, as they found that higher-tier programs had a larger proportion of women leaders with statistical significance after examining 193 programs [ 18 ]. Therefore, while our study did not find a significant difference between the proportion of women in program directorship of the top and bottom 50 of the programs we included, it is likely that there will be a significantly higher proportion of female program directors in the top 100 programs we included vs. the bottom 100.…”

Geriatric proximal femur fracture updates

“…19 In the decision between a cephalic screw or a helical blade, Chapman et al showed that the use of a helical blade is associated with a higher rate of fracture collapse and concomitant screw cut-out. 21 In severely osteoporotic patients, cement augmentation has been demonstrating fewer complications and reoperations and shorter hospital stay at the expense of a slightly longer operation duration. 20 Despite improving surgical techniques and implants, fixation failures such as cut-out and cut-through still occur in elderly osteoporotic patients.…”